Routine Radiology of the Trauma Patient

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Routine Radiology of theTrauma Patient

• Chantal VCA 440

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Introduction
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What to look for in the thorax

• Pulmonary contusions
• Hemothorax
• Pneumomediastinum
• Pneumothorax
• Traumatic diaphragmatic hernia

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Pulmonary Contusions

• How it happens
• Hemorrhage into the lung parenchyma
• Tearing and crushing injury
• Radiographic Signs
• Patchy, focal or generalized
• Alveolar pattern
• May not be visible right away
• Whats next?
• Be conservative with fluids
• Respiratory support
• /- Coagulation tests

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Pulmonary Contusions
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Hemothorax
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Hemothorax

• How it happens
• Trauma to arteries /veins
• Damage to heart, lungs, thymus, or diaphragm
• Ruptured herniated abdominal viscera
• Radiographic signs
• Pleural effusion
• Diffuse or ventral
• Scalloping/fissures
• Whats next?
• Thoracocentesis
• /- Surgical exploration
• Oxygen, transfusion, fluids

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Pneumomediastinum

• How it happens
• Ruptured alveoli, trachea, or esophagus
• Tracheal avulsion
• Radiographic signs
• Distinction of structures normally not seen
• Tracheal wall outlined
• SQ emphysema
• Whats next?
• Repair rents
• Monitor for progression

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Pneumomediastinum
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Pneumothorax
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Pneumothorax

• How it happens
• Chest wall rent
• Lung rupture
• Extension of pneumomediastinum
• Radiographic signs
• Retracted lungs
• /- collapse
• Raised heart
• /-Small heart
• /-flat caudal diaphragm
• /-mediastinal shift
• Whats next?
• Thoracocentesis

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Pneumothorax
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Traumatic Diaphragmatic Hernia

• How it happens
• Rapid increase in intra-abdominal pressure
• Rent in the muscular portion
• Radiographic signs
• /-Pleural effusion
• /-Gas filled loops, liver stomach,spleen
• /-Loss of diaphragmatic outline
• /-Asymmetric on VD/DV
• /-Missing viscera from abdomen
• Whats next?
• Contrast study to definitively diagnose

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The UpperGI
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What to look for in the abdomen

• Hemoperitoneum
• Renal avulsion
• Uroperitoneum
• Traumatic hernias

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Hemoperitoneum

• How it happens
• Ruptured spleen
• Ruptured liver
• Disrupted vasculature
• Avulsed bladder
• Radiographic signs
• Peritoneal effusion
• Focal or diffuse
• Decreased serosal detail
• Whats next?
• U/S
• Abdominocentesis

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Hemoperitoneum
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Renal Avulsion

• Radiographic signs
• Focal decreased serosal detail
• Missing kidney
• Mass in caudal abdomen
• Whats next?
• U/S

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Renal Avulsion
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Renal Avulsion

• Right Kidney

• Left (avulsed) Kidney

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Uroperitoneum

• How it happens
• Ruptured bladder
• Avulsed/torn ureter
• Urethral tear
• Radiographic signs
• Diffuse decreased serosal detail
• Focal detail loss in the RPS
• Whats next?
• Abdominocentesis
• IVP (EU)
• Cystogram
• Urethrogram

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Ruptured Bladder

• The urethrocystogram

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Avulsed or Ruptured Ureter

• The Excretory Urogram

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Ruptured Urethra

• The Urethrogram

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Traumatic Hernia

• How it happens
• Rapid increase in intra-abdominal pressure
• Rent in the body wall, inguinal canal, or
  perineal wall
• Radiographic signs
• Extra-abdominal mass
• Disruption of the body wall
• /-Containing gas-filled loops of intestines
• /-Missing abdominal viscera
• Whats next?
• U/S mass
• Surgical repair

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Traumatic Hernia
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In summary

• Breath
• Stabilize
• Dont get dazzled by an impressive fracture
• Get ALL the info